摘要
目的分析呼吸机相关性肺炎老年患者病原菌分布、相关危险因素为临床护理提供依据。方法以"呼吸机相关肺炎、病原菌、危险因素、老年、护理等"为自由词检索中国知网、中国期刊全文数据库2009年1月至2015年12月收录的文献,阅读原文分析病原菌分布、致病危险因素,进行归纳、汇总及统计。结果 42篇文献被采纳,其中27篇报道老年呼吸机相关性肺炎共2 595例;检出病原体4 129株,其中,革兰阴性杆菌3 149株,革兰阳性球菌644株,真菌326株,非典型病原体10株;相关危险因素有:气管插管(或切开)留置时间和体位(最密切相关)、患有慢性呼吸系统疾病、并发多脏器功能障碍综合征、住院时间>20 d、曾经应用抗菌素、年龄>80岁,意识状态营养状态不佳、呼吸机管路及附件污染等医源性污染等,其中医源性污染贯穿在各项操作活动中。结论机械通气老年患者呼吸机相关性肺炎发病率高,主要致病菌为革兰阴性杆菌感染,相关危险因素复杂多样,护理人员应熟悉并针对性做好病情观察、消毒隔离、手卫生等,同时给予患者正确体位。
Objective To analyze the pathogen distribution and risk factors of ventilator associated pneumonia in elderly patients, so as to provide refer- ences for clinical nursing. Methods Free words of ＂ventilator associated pneumonia, pathogenic bacteria, risk factor elderly, nursing, ere＂ were used to retrieve China National Knowledge Infrastructure （CNKI） and China Journal full - text Database （ Dating from January 2009 to December 2015 ） ,then to analyze the dis- tribution of pathogens and risk factors of ventilator associated pneumonia. Results Forty - two articles were included, of which 27 reported a total of 2 595 cases of senile ventilator - associated pneumonia. The detection of pathogens was 4 129 strains, including 3 149 strains of gram negative bacteria, 644 strains of gram positive bacteria,326 strains of fungus, 10 strains of atypieal pathogens. The risk factors were the indwelling time and position of tracheal intubation or tracheotomy （the most closely related）, patients suffered with chronic respiratory disease, multiple organ dysfunction syndrome, duration of hospitalization more than 20 days, the use of antibiotics, more than 80 years old, the poor state of consciousness and nutrition,the pollution of ventilator pipeline and accessories, and other iatrogenic pollution, which was throughout the operating activities. Condusion The incidence of ventilator associated pneumonia in elderly patients in mechanical ventila- tion is high ,the main pathogens are gram negative bacteria and associated risk factors are complex and diverse. Nurses should be familiar with that and do a good job in observation, disinfection and isolation, hand hygiene, and maintaining patients in correct posture.
出处
《护理管理杂志》
2016年第9期655-657,共3页
Journal of Nursing Administration
基金
军队"十二五"面上课题项目(CWS12J060)
关键词
老年
呼吸机相关性肺炎
病原体
危险因素
护理
elderly
ventilator associated pneumonia
pathogen
risk factors
nursing
